To screen for PSA or not ...? Study links 'not' to higher-risk cancer

February 25, 2015
| by Denise Heady

New research led by City of Hope researcher Timothy Schultheiss found that U.S. Preventive Services Task Force recommendations against the PSA test may be linked to an increase in higher-risk prostate cancer.

The prostate cancer screening debate, at least as it relates to regular assessment of prostate specific antigen levels, is far from over.

The U.S. Preventive Services Task Force recommended against routine PSA screening for prostate cancer in 2012, maintaining that the routine use of the PSA blood test does more harm than good, threatening men's quality of life. Many doctors and other medical professionals, however, never accepted this recommendation as prudent. They've continued to debate, or argue, the benefits and risks of regular prostate cancer screening.

A new study, led by Timothy E. Schultheiss, Ph.D, professor and chief of radiation physics at City of Hope, will add data fuel to the debate fire. In findings presented this week at the 2015 Genitourinary Cancers Symposium in Orlando, Florida, Schultheiss reports that the recommendations against PSA screening for prostate cancer may have led to an increase in higher-risk prostate cancer.

Schultheiss and his colleagues analyzed data on nearly 87,500 men treated for prostate cancer since 2005 and found a 6 percent increase in intermediate and higher-risk cases of the disease between 2011 and 2013. They estimated that the suggested trend could produce an additional 1,400 prostate cancer deaths annually.

"We believe our data indicate that the USPSTF might reconsider their recommendation," Schultheiss said in an interview with HealthDay. "We need to be intelligent about who we screen and who we treat. We're not suggesting that everyone be screened using PSA, but we're not suggesting that no one be screened using PSA."

Prior to 2011, Schultheiss said there had been a steady decline in the percentage of men with prostate cancer with a PSA of 10 or higher, which is the benchmark for intermediate- or high-risk prostate cancer.

"If you don't screen the people, then when they show up with prostate cancer, the horse is out of the barn," Schultheiss said in a press conference. "By missing early disease, then you're going to catch it when it's later, when it's palpable or causing symptoms. And that, of course, makes it much more difficult to treat."

Prostate cancer is the most common cancer, other than skin cancer, among men in the United States and the second-leading cause of cancer death.

“Given the rise in intermediate- and high-risk prostate cancers seen in our analysis during this time frame, men who are at increased risk for prostate cancer, especially those with a family history of prostate cancer, should consider talking with their doctor about PSA screening,” said Schultheiss.

The researchers plan to continue to update this analysis as new data become available.